Autism: Three-Word Phrases to Supported Conversations in 18 Months

Just settling back in from the whirlwind trip to Atlanta, Georgia. ASHA, once again surpassed itself in excellence. My kitchen table is a mass of brochures, notes and folders; re-organized into priority piles. The exhibit hall was replete with samples and gadgets. Now, what to do with that little planter of wheat grass? Yes, I live in northern California; one would think I’d blend that stuff right up in my morning “green drink,” but I think I’ll find another home for it instead.

And, reaching in my zipper-top ASHA bag, there’s more: a pink flamingo clip, a recycled “use your own” grocery bag, a pamphlet on social networking, plenty of memories. Notwithstanding the seminars and short courses which offered a mountain of new information.

I contributed “my rock” of new information this year, too. I had the honor of presenting a case study of an Autistic teen’s language development over an 18 month period. Presenting at ASHA is not new to me, but each time it confirms the fact that we, “ in the trenches” daily clinicians, as opposed to university researchers, have much to offer our colleagues.

ASHA is interested in what we are doing out in the field. Small treatment programs and case studies contribute as much as research coming out of the more prominent universities. ASHA is interested not so much whether a given treatment “worked” (as that word is nebulous in itself) but what did it change? And, how did it change?

So, this case study was a sequential presentation of video clips demonstrating an 18 year-old autistic male’s changes in sentence structure, vocabulary and vocal prosody as he learned from video feedback and the use of a speech generating device. The changes over time have been dramatic and offer us windows into understanding how communication skills can change via use of technology.

Treatment is evidence-based, as I took the best available research about children with autism and video monitoring and then applied my clinical best-practice knowledge, along with his values and interests. Computers enthralled him and Disney is his favorite subject! His comments confirm this.

Combining the use of point-of-view virtual feedback, audio and video self-editing, self-modeling, repetition and practice speaking with a monitor rather than a person, we witnessed movement starting with our teen bolting perseverative repetitive words and phrases across to phases of dependence on written scripts or memorized lines through his success with short supported conversations.

The videos showed a continuum of his vocal changes and the sweet exploration of facial expressions related to his intentions of message delivery. We also watched his ever-growing vocabulary, including the use of temporal and spatial relationships.

Seminar attendees fell in love with this charming young man as they learned how he mastered the use of a speech generating device, including developing his own customized digital icon library as well as video editing and review. They learned how he independently wrote and recorded his own comments and attached them to his personal photos, all in an effort to share the events in his life.

Besides considering the use of a *Lingraphica SGD (utilized in the study), one might be creative and use a tablet, a laptop with a video camera, or an app which would lenditself to video modeling techniques. The course demonstrated how existing research and the availability of developing standardized communication models for independent practice outside of the therapy environment, can substantiate a treatment model of cost efficiency. The new formula of “treatment / cost = value” is alive and well with this treatment model, which focuses on extensive independent study.

Did you miss the session? You may still be able to download the handout which gives an overview and bibliography. I have been using some of the same techniques with my other patients and keeping close track of their changes. Stay tuned; we may see significant outcomes with other populations as well.

I am in the process of developing an online CEU course which you could download with these wonderful video-clips. So, to whet your appetite for more; here are two clips from the course. First, a baseline and then a delightful supported conversation Talking about what? Disney, of course. Enjoy the videos.

*Disclaimer: I have no fiduciary relationship with either Lingraphicare or Disney Productions.

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